Provider Demographics
NPI:1750463212
Name:HENNINGER, ERIC JASON
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JASON
Last Name:HENNINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 2ND STREET SW
Mailing Address - Street 2:COMDT (CG-1122), U.S. COAST GUARD, SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND STREET SW
Practice Address - Street 2:COMDT (CG-1122), U.S. COAST GUARD, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20953
Practice Address - Country:US
Practice Address - Phone:252-335-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other